Classification of blood pressure for adults

CategoryCategory

Blood Pressure (mmHg)Blood Pressure (mmHg)

SystolicSystolic DiastolicDiastolic

OptimalOptimalNormalNormalHigh-normalHigh-normalHypertensionHypertension Stage 1Stage 1 Stage 2Stage 2 Stage 3Stage 3

<120<120<130<130130-139130-139

140-159140-159160-179160-179>180>180

<80<80<85<8585-8985-89

90-9990-99100-109100-109>110>110

Classification of hypertension

AdolescentsAdolescents (13-15)(13-15) SystolicSystolic DiastolicDiastolicAdolescentsAdolescents (16-18)(16-18) SystolicSystolic DiastolicDiastolicAdults (>18)Adults (>18) SystolicSystolic DiastolicDiastolic

MildMild(stage 1)(stage 1) mmHgmmHg

135-139135-13985-8985-89

140-149140-14990-9490-94

140-149140-14990-9990-99

140-149140-14990-9490-94

150-159150-15995-9995-99

160-179160-179100-109100-109

150-159150-15995-9995-99

160-179160-179100-109100-109

180-209180-209110-119110-119

>160>160>110>110

>180>180>110>110

>210>210>120>120

ModerateModerate(stage 2)(stage 2) mmHgmmHg

SevereSevere(stage 3)(stage 3) mmHgmmHg

Very SevereVery Severe (stage 3)(stage 3) mmHgmmHg

HYPERTENSIONHYPERTENSION

Severe or refractory HTNSevere or refractory HTN Acute rising BP in well-controlled HTNAcute rising BP in well-controlled HTN Age of onset <20 or >70 years-oldAge of onset <20 or >70 years-old Acute rising Cr,especially with ACE-IAcute rising Cr,especially with ACE-I Diffuse atherosclerosisDiffuse atherosclerosis Asymmetric kidneysAsymmetric kidneys Abdominal bruitAbdominal bruit No family history of HTNNo family history of HTN

NONO

Essential Essential HTNHTN

Severity of blood pressure levelsSeverity of blood pressure levels

Between 140/90 to 160/105 mmHgBetween 140/90 to 160/105 mmHg >160/105 mmHg>160/105 mmHg

Check for target organ damage:Check for target organ damage:Heart, cardiac risk factors,LVHHeart, cardiac risk factors,LVH Retinopathy greater than grade IIRetinopathy greater than grade II Renal insufficiency:proteinuriaRenal insufficiency:proteinuriaH/O TIA, strokeH/O TIA, stroke

No Aerobic Exercise • • Antihypertensive drugsAntihypertensive drugs• • Treat complicationsTreat complications

Yes

YesYes

Secondary HTNSecondary HTNPrimary renalPrimary renal deseasedeseaseOral contracept.Oral contracept. Pheo.Pheo. Hyperaldost.Hyperaldost.CushingCushing HyperthyroidismHyperthyroidism Sleep ApneaSleep Apnea Ao CoarctationAo Coarctation

Treat by medicine or surgery

Increase IntravascularIncrease Intravascular blood volumeblood volume • • obesityobesity • • diet intakediet intake

Increase IntravascularIncrease Intravascular blood volumeblood volume • • obesityobesity • • diet intakediet intake

Increase inIncrease in• • heart rateheart rate• • contrctilitycontrctility

Increase inIncrease in• • heart rateheart rate• • contrctilitycontrctility

Increased Increased Adrenergic activityAdrenergic activity• • HyperinsulinemiaHyperinsulinemia• • Insulin resistenceInsulin resistence

Increased Increased Adrenergic activityAdrenergic activity• • HyperinsulinemiaHyperinsulinemia• • Insulin resistenceInsulin resistence

Increase Increase cardiac outputcardiac output

Increase Increase cardiac outputcardiac output

Neuro-humoral SystemNeuro-humoral System• • RASRAS• • Atrial reflexesAtrial reflexes• • VasopressinVasopressin• • ANPANP• • Endothelial factorsEndothelial factors

Neuro-humoral SystemNeuro-humoral System• • RASRAS• • Atrial reflexesAtrial reflexes• • VasopressinVasopressin• • ANPANP• • Endothelial factorsEndothelial factors

ResetResetBaroceptorBaroceptor

ResetResetBaroceptorBaroceptor

Increase smooth muscle Increase smooth muscle tone and vascular tone and vascular

resistence resistence

Increase smooth muscle Increase smooth muscle tone and vascular tone and vascular

resistence resistence

Target organ damage:Target organ damage:Brain - Cardiovascular Brain - Cardiovascular

Retina - KidneysRetina - Kidneys

Target organ damage:Target organ damage:Brain - Cardiovascular Brain - Cardiovascular

Retina - KidneysRetina - Kidneys

HypertensionHypertensionHypertensionHypertension

LVHLVHLVHLVHCardiacCardiaccompliancecomplianceCardiacCardiaccompliancecompliance

Decrease Decrease cardiac outputcardiac output

Decrease Decrease cardiac outputcardiac output

44

-10-10

-12-12

-16-16

-14-14

22

00

-2-2

-4-4-6-6

-8-8

Systolic BPSystolic BP Diastolic BPDiastolic BP

All 48All 48comparisonscomparisons

14 comparisons14 comparisons In hypertensivesIn hypertensives

7 comparisons7 comparisons In Border LineIn Border Line hypertensiveshypertensives

27 comparisons27 comparisons In normotensivesIn normotensives

Results of a meta-analysis of controlled trials testing aerobic exercise and blood pressure

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